Inside the NCLEX-RN: A Realistic Scenario Every Overseas Nurse Should Know

 Preparing for the Australian NCLEX-RN as an overseas nurse can feel overwhelming, especially when you're unsure what to expect on exam day. While knowing the content areas is essential, practicing with realistic scenarios is what truly builds confidence. In this blog post, we’ll walk through a sample case that mirrors the type of clinical decision-making you’ll encounter on the exam.

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Scenario: Prioritising Care in a Busy Medical Ward

You are a registered nurse working the morning shift in a general medical ward. You’ve just received handover for four patients. Based on the information below, which patient should you see first?

Patient A:

70-year-old male with COPD. He is scheduled for a chest X-ray in 45 minutes. He is alert, has an oxygen saturation of 91% on 2L via nasal cannula, and is complaining of a mild headache.

Patient B:

45-year-old female post-op appendectomy. Her pain is 7/10 despite her last dose of analgesia being an hour ago. Her vital signs are stable.

Patient C:

60-year-old male admitted for heart failure. He is short of breath, has bibasal crackles, oxygen saturation of 88% on room air, and reports sudden weight gain of 2 kg overnight.

Patient D:

30-year-old female with newly diagnosed diabetes. She is due for her first insulin injection and is asking questions about the administration technique.

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Answer and Rationale:

Priority Patient: Patient C

This patient shows signs of acute decompensated heart failure, a potentially life-threatening condition. His shortness of breath, low oxygen saturation, crackles on auscultation, and sudden weight gain indicate fluid overload and poor perfusion. Delaying assessment could lead to respiratory distress or cardiac complications.

In NCLEX terms, this question tests your ability to prioritize care using the ABC framework (Airway, Breathing, Circulation). Patient C has the most urgent need based on impaired breathing and possible fluid retention. Even though other patients have valid concerns, they are not immediately life-threatening.

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Why This Matters on the NCLEX-RN

This is a classic example of a management of care question—one of the most frequently tested areas. It evaluates your decision-making in a clinical setting, not just your knowledge of disease processes. The NCLEX-RN wants to know: can you recognize subtle changes in patient status? Can you prioritize effectively? Can you take safe and timely action?

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How to Practice These Scenarios

• Use question banks that offer case-based questions (UWorld and Kaplan are popular options).

• Practice applying frameworks like ABCs, Maslow’s Hierarchy, and Stable vs. Unstable patients.

• Review rationale—even for questions you get right—to solidify your clinical reasoning.

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Final Thoughts

Passing the NCLEX-RN isn’t about memorizing facts—it’s about thinking like a nurse. Scenarios like this one train your mind to assess quickly, prioritize accurately, and act safely. With regular practice and a strategic study plan, you’ll be ready to face these questions with confidence and begin your nursing career in Australia.

What the Australian NCLEX-RN Exam Covers: A Comprehensive Guide for Overseas Nurses

 

The Australian NCLEX-RN (National Council Licensure Examination for Registered Nurses) is a pivotal assessment for internationally qualified nurses who aspire to practice in Australia. Since the introduction of the Outcome-Based Assessment (OBA) pathway by the Nursing and Midwifery Board of Australia (NMBA), the NCLEX-RN has become the first major hurdle in the registration process for overseas nurses. This exam, adopted from the U.S. and Canadian nursing boards, is designed to assess whether a candidate possesses the knowledge, skills, and judgment required to provide safe and effective nursing care.

In this comprehensive guide, we’ll break down what the NCLEX-RN exam covers, providing overseas nurses with the clarity and direction needed to prepare effectively.

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Understanding the NCLEX-RN Framework

The NCLEX-RN is not a traditional knowledge-based exam. Instead, it is competency-based, meaning it evaluates your ability to make clinical decisions, apply nursing concepts, and deliver safe care in real-life scenarios. The exam uses a Computerized Adaptive Testing (CAT) format, which adjusts the difficulty of questions based on your performance. The number of questions you receive will vary between 75 and 145, and you’ll have a maximum of 5 hours to complete the exam.

The exam is based on the NCLEX-RN Test Plan, developed by the National Council of State Boards of Nursing (NCSBN). The test plan is updated every three years and outlines the major content categories that nurses must master.

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Major Content Categories of the NCLEX-RN

The NCLEX-RN is divided into four main Client Needs categories, with some categories further divided into subcategories:

1. Safe and Effective Care Environment

This section evaluates your ability to manage patient care in a safe, structured, and ethical manner. It includes two subcategories:

• Management of Care (17–23%)
  This area tests your knowledge of delegation, prioritization, supervision, legal and ethical responsibilities, and client rights. Topics include:

  • Advanced directives and informed consent

  • Case management and continuity of care

  • Assignment and supervision

  • Confidentiality and information security

  • Legal and ethical practice

  • Advocacy and resource management

• Safety and Infection Control (9–15%)
  Here, you’ll be tested on how well you prevent injury and infection. Topics include:

  • Medical and surgical asepsis

  • Handling hazardous materials

  • Standard and transmission-based precautions

  • Fall prevention and patient identification

  • Safe use of equipment and restraints

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2. Health Promotion and Maintenance (6–12%)

This category focuses on growth and development, prevention, and early detection of health problems. You’ll need to demonstrate understanding of:

• Normal physical and emotional development

• Health screenings and immunizations

• Lifestyle choices and health promotion strategies

• Antepartum, intrapartum, postpartum, and newborn care

• Aging process and transitions in care

• Risk behaviors and self-care education

This part of the exam emphasizes preventive care and patient education—skills essential for nurses in promoting long-term well-being.

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3. Psychosocial Integrity (6–12%)

This section evaluates your understanding of mental health and the psychological well-being of patients. It includes care related to:

• Coping mechanisms and support systems

• Therapeutic communication

• Crisis intervention

• Substance abuse disorders

• Behavioral interventions

• End-of-life care and grief

• Mental health disorders such as depression, schizophrenia, and anxiety

You will be expected to recognize signs of emotional distress and implement appropriate interventions.

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4. Physiological Integrity

This is the most extensive category, covering direct physical care and critical nursing interventions. It is divided into four subcategories:

• Basic Care and Comfort (6–12%)
  Focuses on assisting patients with daily living activities. Topics include:

  • Mobility and hygiene

  • Nutrition and elimination

  • Non-pharmacological comfort interventions

  • Palliative care

• Pharmacological and Parenteral Therapies (12–18%)
  Assesses your ability to administer and monitor medications. Includes:

  • Medication dosage calculations

  • Adverse effects and interactions

  • Intravenous therapies

  • Blood transfusions

  • Central line care

• Reduction of Risk Potential (9–15%)
  Involves recognizing complications and taking preventive actions. Topics include:

  • Postoperative care

  • Laboratory and diagnostic tests

  • Therapeutic procedures

  • Early detection of complications

  • Managing medical emergencies

• Physiological Adaptation (11–17%)
  Covers the management of acute, chronic, and life-threatening conditions. Topics include:

  • Fluid and electrolyte imbalances

  • Cardiovascular, respiratory, renal, and neurological disorders

  • Medical emergencies (e.g., anaphylaxis, cardiac arrest)

  • Hemodynamic monitoring and ventilator care

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Question Types in the NCLEX-RN

The exam uses a variety of question formats to assess different aspects of nursing practice. These include:

• Multiple Choice – Standard question with four options.

• Select All That Apply (SATA) – Multiple correct answers.

• Drag-and-Drop – Ordering procedures or priority actions.

• Hot Spot – Selecting a specific area on an image (e.g., anatomy or injection site).

• Fill-in-the-Blank – Especially for medication calculations.

• Exhibit and Chart Questions – Review patient charts and make decisions.

The inclusion of alternate question types requires not only knowledge, but strong critical thinking and test-taking strategies.

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Clinical Judgment in the NCLEX-RN

One of the most important updates to the NCLEX-RN exam is the focus on Clinical Judgment, introduced as part of the Next Generation NCLEX (NGN) model. This framework assesses your decision-making abilities in realistic scenarios involving:

1. Recognizing and analyzing cues

2. Prioritizing hypotheses

3. Generating solutions

4. Taking actions

5. Evaluating outcomes

Overseas nurses must be prepared to assess patient scenarios holistically and apply judgment under pressure. This focus mirrors real-world expectations of Australian nurses.

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Conclusion: Study with a Strategic Focus

Understanding what the NCLEX-RN exam covers is the first major step toward passing it. Overseas nurses preparing for this exam should study according to the four major content areas, while also emphasizing clinical judgment and patient safety. It’s not just about memorizing facts—it’s about applying them effectively in clinical settings.

Use practice exams to identify weak areas, strengthen core concepts with resources like UWorld or Saunders, and simulate test conditions regularly. With the right preparation and a clear grasp of the exam structure, you’ll be well on your way to achieving success on the NCLEX-RN and launching your nursing career in Australia.

How to Pass the Australia NCLEX-RN as an Overseas Nurse

 Passing the Australian NCLEX-RN (National Council Licensure Examination for Registered Nurses) is a critical step for overseas-trained nurses who wish to practice in Australia. Introduced by the Nursing and Midwifery Board of Australia (NMBA) as part of the Outcome-Based Assessment (OBA) process, the NCLEX-RN assesses your readiness to practice safely and effectively. Here’s a concise guide to help you succeed.

1. Understand the OBA Process

The OBA consists of two main components: the NCLEX-RN and the OSCE (Objective Structured Clinical Examination). As an internationally qualified nurse, you must first pass the NCLEX-RN before attempting the OSCE. Start by checking your eligibility with the Australian Health Practitioner Regulation Agency (AHPRA), which reviews your qualifications, experience, and English proficiency.

2. Know the NCLEX-RN Format

The NCLEX-RN is a computer adaptive test that tailors questions based on your performance. It covers four key areas:

• Safe and Effective Care Environment

• Health Promotion and Maintenance

• Psychosocial Integrity

• Physiological Integrity

Expect a mix of multiple-choice, select-all-that-apply, drag-and-drop, and fill-in-the-blank questions. The number of questions ranges from 75 to 145, and the maximum time is five hours.

3. Create a Study Plan

Consistency is key. Develop a study schedule that spans 2–3 months, focusing on daily practice and review. Break down topics into manageable chunks, and allocate time for practice tests and content review. Tools like UWorld, Kaplan, or Saunders NCLEX prep books can be invaluable for high-yield questions and rationales.

4. Practice with NCLEX-Style Questions

Familiarity with question style is essential. Use question banks to simulate the real exam environment. After each session, review rationales thoroughly—even for questions you got right. This deepens understanding and reinforces concepts.

5. Focus on Critical Thinking

The NCLEX-RN isn’t just about knowledge—it’s about applying it in clinical scenarios. Practice prioritization (e.g., ABCs: Airway, Breathing, Circulation), delegation, and critical decision-making skills. Learn to eliminate distractors and choose the safest, most effective response.

6. Strengthen Weak Areas

After several practice tests, identify your weak areas—such as pharmacology, mental health, or maternal nursing—and dedicate extra time to mastering them. Use visual aids, flashcards, and online videos to reinforce complex topics.

7. Take Care of Yourself

Don’t neglect your physical and mental well-being. Ensure you get adequate sleep, eat well, and take breaks. Stress management techniques such as deep breathing or short walks can help keep your mind fresh and focused.

8. Exam Day Preparation

On exam day, arrive early and bring valid identification. Stay calm and confident. Trust your preparation, and remember that each question is an opportunity to demonstrate your readiness.

In Summary

To pass the Australian NCLEX-RN as an overseas nurse, you need a strategic, disciplined approach. Understand the exam format, follow a structured study plan, practice extensively, and focus on clinical judgment. With persistence and smart preparation, you can successfully take this important step toward becoming a registered nurse in Australia.

OSCE Budgeting Checklist & Cost Estimator (AUD)

 

Item	Estimated Cost (AUD)	✅
OSCE Exam Fee (ANMAC)	$4,000
NCLEX-RN Exam Fee (if applicable)	$400–$500
OSCE Preparation Course	$1,500–$3,000
Travel to Adelaide (flights, return)	$200–$1,000
Accommodation (2–5 nights)	$200–$700
Local Transport & Meals	$100–$300
English Test (IELTS, OET, PTE, etc.)	$350–$400
AHPRA Application & Registration Fees	$300–$600
Police Check / Cert. Docs Translation	$100–$200
Health Checks / Immunisations	$100–$300
Stationery / Study Materials	$50–$100
Emergency Buffer / Resit Reserve	$500–$1,000

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✏️ How to Use This:

1. Tick the ✅ boxes as you complete or pay for each item.

2. Add your personal cost beside each row (if different from the estimate).

3. Sum the total to understand how much you’ll need to budget.

4. Keep a buffer of at least 10–15% extra for unexpected expenses.

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💰 Estimated Total Cost Range:

• Low Estimate: ~$7,500 AUD

• High Estimate: ~$12,000 AUD

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🧠 Pro Tips:

• Book your accommodation and flights early to save on travel.

  
  
  

• Join Facebook groups or forums to find shared housing or budget options.

• Some prep providers offer bundled packages (training + accommodation).

• Consider using budgeting apps (like Pocketbook or Goodbudget) to track your spending.

Is the OSCE Worth It? Understanding the Costs & What to Know Before You Book

 For internationally qualified nurses dreaming of a career in Australia, the Objective Structured Clinical Examination (OSCE) is often the final checkpoint before registration. But while the goal is clear, the cost of the journey can be a serious consideration—especially for nurses funding the process themselves.

So how much does the OSCE really cost, and what should you consider before committing to the exam? Let’s break it down.

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🧾 What Is the Cost of the OSCE?

As of 2025, the OSCE fee is AUD $4,000 (subject to change). This fee is payable to the Australian Nursing and Midwifery Accreditation Council (ANMAC) and covers the full clinical examination, usually conducted in Adelaide.

This amount does not include:

• Travel or accommodation costs if you’re flying into Adelaide

• Visa fees if you're travelling from overseas

• Preparation courses or tutoring

• Additional costs if you need to resit the exam (another AUD $4,000)

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✈️ Other Hidden or Related Expenses

1. Preparation Courses: While not mandatory, most nurses take OSCE coaching programs, which can cost AUD $1,500–$3,000, depending on the provider and length of the course.

2. Travel & Stay in Adelaide: Budget at least AUD $800–$1,500 for flights, 2–5 nights of accommodation, food, and transport—more if you’re arriving internationally.

3. English Language Tests (if needed): IELTS, OET, PTE, or TOEFL exams can cost between AUD $350–$400 each.

4. Documents & Registration Fees: You’ll also pay fees for AHPRA registration, police checks, and certified translations if applicable—adding another AUD $300–$600.

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🤔 What to Consider Before Taking the OSCE

1. Are You Ready?

Don’t book your OSCE just to “give it a try.” It’s a high-stakes, expensive test. Make sure you’ve had enough hands-on practice and are comfortable with clinical skills, documentation, and communication standards required in Australian healthcare.

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2. Do You Understand the Exam Format?

Study past OSCE structures, station types, and marking criteria. Join online forums, talk to those who’ve passed, and attend webinars or mock exams if possible.

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3. Can You Afford a Second Attempt?

While many pass on their first try, not everyone does. Be emotionally and financially prepared for the possibility of needing to resit the exam. It’s tough, but not uncommon.

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4. Is Your AHPRA Application in Order?

Only candidates who’ve been approved through the Self-check and OBA pathway are eligible to take the OSCE. Make sure all your documents are accepted, and you've passed the NCLEX-RN first (if required).

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5. Do You Have Support?

Preparing for the OSCE can be lonely and stressful. Consider joining a study group, getting a mentor, or enrolling in a structured program. Moral support makes a big difference—especially if you’re studying while working or caring for a family.

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🧭 Final Thoughts

The OSCE is an investment—in your future, your career, and your dreams. It’s not cheap, but for many nurses, it leads to better opportunities, a higher standard of living, and a fresh start in a welcoming country.

Just be sure to plan ahead, prepare well, and go in with both eyes (and hands) open.

Failing Forward: Common OSCE Mistakes Nurses Make—And How to Avoid Them

 he Objective Structured Clinical Examination (OSCE) is one of the most important hurdles for internationally qualified nurses seeking registration in Australia. While it’s normal to feel nervous, being aware of common pitfalls can help you walk into the exam room with confidence—and walk out with success.

Let’s explore the top mistakes candidates make during the OSCE, and most importantly, how to avoid them.

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❌ 1. Skipping Hand Hygiene or Improper PPE Use

The mistake: Many candidates either forget to wash their hands before and after procedures or misuse personal protective equipment (PPE).

How to avoid it: Hand hygiene is non-negotiable in every station. Practise it until it becomes second nature. Also, review when and how to properly use gloves, masks, and gowns based on the clinical scenario. Always assume you’re working in a real hospital.

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❌ 2. Poor Time Management

The mistake: Candidates often spend too much time on one part of the task, leaving other sections incomplete.

How to avoid it: Practise OSCE scenarios with a timer. Each station is usually 8–10 minutes, so allocate time wisely:

• 1 minute to read the scenario

• 2–3 minutes to assess

• 2–3 minutes to implement

• 1–2 minutes to close and document

Stick to your plan, and if you feel stuck—move on.

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❌ 3. Lack of Therapeutic Communication

The mistake: Being too task-focused and not engaging with the "patient" appropriately.

How to avoid it: Remember—communication is a clinical skill. Always introduce yourself, ask for consent, and explain what you're doing. Use empathetic, non-judgmental language and actively listen. Practise SBAR for handovers and teach-back methods for patient education.

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❌ 4. Incomplete Documentation

The mistake: Leaving out key findings or not using standard nursing language when documenting.

How to avoid it: Review sample nursing notes and SOAP or DAR format. Focus on clarity, accuracy, and relevance. Practice writing quick and concise notes during your mock OSCEs.

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❌ 5. Not Reading the Scenario Instructions Carefully

The mistake: Jumping into the task without understanding what the station is actually testing.

How to avoid it: Use the first minute to read the prompt carefully. Are they asking you to assess, educate, escalate, or treat? Misinterpreting the task can cost points even if your clinical skills are solid.

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❌ 6. Panicking or Freezing Mid-station

The mistake: Losing composure after making a mistake and letting it affect the rest of the station.

How to avoid it: Stay calm. If you make an error, correct it professionally and move on. OSCE assessors don’t expect perfection—they’re watching how you respond under pressure.

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✅ Final Thoughts

The OSCE isn’t just a test of skills—it’s a test of confidence, communication, and professionalism. Preparation is key, but so is mindset. Be kind to yourself, practise regularly, and treat each mock scenario like it’s real.

Avoiding these common mistakes can make all the difference between a re-sit and a registration letter. You've come this far—finish strong. 💪

PrepNurse Australia: The Ultimate Online Hub for OSCE Success

 

For internationally qualified nurses, passing the Objective Structured Clinical Examination (OSCE) is a major milestone toward becoming registered in Australia. But what if there was one central place online—accessible from anywhere in the world—that could help you study, practise, and connect with other nurses just like you?

Introducing PrepNurse Australia – a virtual platform designed by nurses, for nurses, to support your OSCE preparation journey from start to finish.

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🖥️ What is PrepNurse Australia?

PrepNurse Australia is an all-in-one website created to help overseas nurses build the skills, confidence, and knowledge needed to pass the OSCE. Whether you're based in India, the Philippines, Nigeria, Brazil, or the UK, this site is your go-to practice hub, available 24/7.

No matter your time zone or study schedule, PrepNurse brings the OSCE lab experience to your fingertips.

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🔍 Key Features of the Website

📚 1. Interactive OSCE Station Library

Browse a growing database of realistic practice stations, including:

• Wound care

• Medication administration

• Aseptic technique

• Mental health scenarios

• Acute patient assessments

Each station comes with:

• Instructions and patient notes

  
  
  

• Sample responses

• Common mistakes to avoid

• Marking criteria breakdown

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🎥 2. Video Demonstrations

Watch step-by-step video guides showing correct technique, communication strategies, and documentation tips—all based on Australian nursing standards.

You'll find walkthroughs by experienced Australian RNs, so you know exactly what examiners are looking for.

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🧑‍💻 3. Live Practice Sessions and Webinars

Book live, tutor-led sessions with trained OSCE instructors who provide:

• One-on-one or group practice

• Mock OSCE assessments

• Feedback tailored to your performance

• Tips for time management and confidence-building

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🌐 4. Community Forums & Study Groups

Connect with other overseas nurses from across the globe. Share experiences, ask questions, and even form virtual study buddies. A dedicated mentorship corner lets you hear from nurses who’ve already passed the OSCE and are now working in Australia.

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📋 5. Checklists and Study Planners

Stay organized with downloadable study plans, weekly practice checklists, and exam-day check-ins to keep your prep on track.

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💬 Why It Matters

Studying alone can be overwhelming. The OSCE isn't just about clinical skill—it's about confidence, clear communication, and adapting to the Australian context. PrepNurse makes sure you're not doing it alone.

We understand the pressure, the sacrifices, and the hope you carry with you. That’s why PrepNurse is more than just a study tool—it’s a support system.

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🧭 Ready to Begin?

PrepNurse Australia is currently free to join for early users and is accessible on mobile, tablet, or desktop. You can create an account, choose your study track, and start your OSCE journey with full access to all resources.

Start practising like you're already there—because your future as a registered nurse in Australia is within reach.